| Skin Care | | | | Because your blood flows more slowly after SCI, your healing ability is reduced. In addition, your skin cannot tolerate as much pressure as before. Your skin can now tolerate a minute amount of pressure for a long time, but it can only tolerate great pressure for a short time before the circulatory system is disrupted and a pressure or skin sore results. |
The decrease in circulation and lower tolerance for pressure is further aggravated by the lack of sensation after SCI. This lack of sensation means there is no longer a feedback mechanism to tell you that there is a problem - that you have been sitting too long without moving or that you have injured yourself, for example.
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The major causes of skin sores are: | • Prolonged pressure
• Bruises or scrapes
• Prolonged wetness on the skin
• Burns
• Sitting or lying on hard objects
• Frostbite
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Other Things That Increase Your Chance of Getting a Pressure or Skin Sore: | • Skin wet from sweat, urine or stool
• Poor nutrition causing anemia (low blood count) and low protein
• Slouching in bed or in the wheelchair
• Fevers
• Bumps or other injuries to the skin
• Friction to the skin, caused by sliding or being pulled across a surface,
or by spasms
• Clothing, braces, splints, etc., that are too tight
• Forgetting or neglecting to take care of yourself if feeling depressed
or when drinking too much alcohol or abusing drugs
• Worn out or improper equipment
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Progression of Skin Sores | | A skin sore begins as a red area on the skin. This reddened area may or may not feel hard and/or hot. If you have black skin, the area may appear shiny instead of red. At this stage, the progression is reversible. You must remove all pressure from this area until the skin returns to its normal color. |
If pressure is not removed, a blister, pimple or scab may quickly form over the hard red area of the skin. This hard red area of skin means that the tissue underneath is dying. At this point, remove all pressure over the area and consult your physician.
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How a pressure sore develops and what to watch for:- | | |  |
Prevention of Skin Sores: Body Check | | | In order to prevent skin sores, you must:
· Check your whole body frequently
· Relieve skin pressure
· Take routine care of your skin
Check your whole body, but pay special attention to bony areas by inspecting your skin at least twice daily. Morning and evening body checks when dressing or undressing is recommended. You can spot a problem at the very beginning. Checking your skin is your responsibility and the way to spot the warning signals of a problem. Don't just ask someone else how your skin looks. If you need someone to help you check, you must be able to tell him or her what to look for. Use a long-handled mirror to help you see your skin. If you need help, ask someone to position mirrors for you - one at the head and one over the pressure point.
Watch for any areas previously broken and healed over - scar tissue breaks easily.
You are looking for: Redness, blisters, opening in skin, rashes, etc. Feel for heat in red areas with the back of your fingers.
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How To Relieve Skin Pressure In A Wheelchair | | | Weight Shifts:
Weight shifts are the most essential techniques for preventing pressure on the skin and muscle of the sacrum (tailbone) and each hip. Use the method you and your therapists have found to be the most effective for you. Know your skin tolerance at all times. The frequency with which you do weight shifts vary from time to time.
Cushions:
A cushion for your wheelchair is essential. Cushions provide pressure relief and weight distribution and thus aid in the prevention of pressure sores. Many types of cushions exist, but there is no "ideal" cushion. Use the cushion recommended by your physical therapist/physiatrist.
. If air is used in the cushion, check to see that it is filled correctly. If you are going to a different altitude, there will be a change in your cushion.
. If your cushion is made of foam, check to see that it is firm and in good condition. If it gets dry, powdery and loses its firmness, replace it immediately. Use only good quality foam. Polyurethane foam with a density of 1.2 and compression of 30 to 35 is recommended.
. In case of body weight change, you may need to change the width of your chair, the frequency of your weight shifts, and the type of cushion you use.
Never use rubber air rings or rubber doughnuts. They are dangerous because they block the flow of blood to the skin inside the leg. Weight shifts are essential. The cushion alone will not prevent pressure sores.
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